All codes
T538
T538 – T538
OHIP Other Code · Schedule of Benefits
When to Use
- Use T538 for the surgical repair of a complete third-degree perineal laceration involving the anal sphincter and rectal mucosa.
- Apply this code when performing a secondary repair of a perineal laceration that requires formal reconstruction of the anal sphincter mechanism.
Common Pitfalls
- Billing T538 in conjunction with a standard vaginal delivery code (e.g., S510) is often flagged for audit; ensure the operative report clearly justifies the complexity of the repair.
- Do not bill T538 if the repair is limited to a second-degree laceration, as this is included in the global delivery fee; use this code only for third or fourth-degree tears.
Billing Tips
- Ensure the operative report explicitly documents the involvement of the anal sphincter and rectal mucosa to support the high-value fee associated with this procedure.
Provider Fee$1,541.73
Specialist Fee$1,541.73
Effective: February 1, 2011
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.